Provider Demographics
NPI:1902052046
Name:SAMUELS, DOUGLAS DENNIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DENNIS
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SCHRAALENBURGH RD
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641
Mailing Address - Country:US
Mailing Address - Phone:201-384-4111
Mailing Address - Fax:
Practice Address - Street 1:330 SCHRAALENBURGH RD
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641
Practice Address - Country:US
Practice Address - Phone:201-384-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ355100153200103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent